Understanding Patient Attitudes Towards Active Surveillance in Prostate Cancer

Prostate Cancer Statistics in Canada

In 2016, over 20,000 Canadians received a diagnosis of prostate cancer, making it the most prevalent cancer among men. For many patients, facing a prostate cancer diagnosis can be daunting, leading them to seek immediate treatment options. However, it is important to note that not all prostate cancer cases necessitate urgent or aggressive intervention; most are slow-growing and may not present harmful effects for years, if at all. In fact, men who live into their eighties often succumb to other causes rather than the slow-growing prostate cancers they may have.

Active Surveillance as a Treatment Option

For patients with low-risk prostate cancer, urologists often recommend active surveillance (AS) as a viable treatment option. Active surveillance involves postponing treatment until there is clear evidence of disease progression. This approach differs significantly from ‘watchful waiting,’ which entails no intervention until symptoms arise. Active surveillance requires meticulous monitoring, including more frequent follow-ups, PSA screening, and repeat biopsies. Research indicates that patients classified as low-risk can benefit from AS, as it allows for the identification and treatment of more aggressive cancer forms while sparing many patients from unnecessary surgeries or radiation.

Patient Perspectives on Active Surveillance

Despite the advantages of active surveillance, some patients may still opt for more invasive treatments. This raises an important question: what are the reasons behind these choices? In the 2017 edition of BMC Urology, researchers explored the attitudes of Canadian patients towards active surveillance. They conducted focus group interviews with 52 low-risk prostate cancer patients across several major cities. These discussions provided insights into the patients’ feelings about their diagnosis and their understanding of active surveillance.

Most participants expressed apprehension about living with a cancer diagnosis without immediate intervention. However, a comprehensive understanding of active surveillance alleviated many of these concerns. Patients recognized that enduring the rigors of close monitoring was preferable to the potential adverse effects of more invasive treatments. When physicians effectively communicate the benefits of AS, many patients are willing to adopt this approach.

The Role of Physician Communication

The study emphasized the critical role of communication between patients and clinicians. Interviews revealed that patients with negative views toward active surveillance often cited a lack of information and guidance regarding its pros and cons. The way active surveillance is presented by the physician significantly influences a patient’s acceptance of it as a reasonable management strategy.

Conclusion: Strengthening the Patient-Physician Relationship

Research findings underscore the importance of the patient-physician relationship in navigating treatment options. The efficacy of medical science is closely tied to how well information is communicated. Providing accessible information and having a supportive provider are essential in keeping patients engaged and involved in their healthcare decisions.

Reference

Fitch, et al. “Canadian men’s perspective about active surveillance in prostate cancer: need for guidance and resources.” BMC Urology. (2017) 17:98. DOI: 10.1186/s12894-017-0290-7.